Laserfiche WebLink
� h. <br /> l I.�.�;F.�". <br /> 4:i ��84 ' <br /> � ° ���'� j a <br /> ` K ` * � .: � CI7�Y of ORONO <br /> 4 '� � <br /> S'�'f E !' '"4��. <br /> f 4 i � b: �'� �.' <br /> * E �����.�N , Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> � ����� _ <br /> ���`.� �: <br /> .���� �'�;���,�Y On the North Shore of Lake Minnetonka <br /> ���,�, <br /> _ ;.. _. <br /> DATA__PRIVACY ADVISORY <br /> In accordance with M.S. 15.165, "Righ�s of subjects of data", we <br /> would Iike to inform you that your request for a permit or license <br /> from the City of Orono �r any of its departments may require you to <br /> furnish certain private or confidential information. <br /> You are notified that: <br /> l. The information you furnish will be used to determine your <br /> qualification for the permit or Iicense requested. <br /> 2. You may refuse to supply data, but refusal may require that <br /> the City deny the permit or license. <br /> 3. The information may be shared with other local , state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or license requires Council action <br /> to approve, some information may become pubZic. <br /> 5. You have certain rights under M.S. 15.165 to review private <br /> data on yourself. <br /> 6. Your full name, and date of birth are required to process <br /> this application or permit. <br /> , , <br /> ��G''�� �_ � � _..� ) ;�l,' s L� � �" <br /> , .� � � � - <br /> ._----- _ _- <br /> �='�- - ---- --.._. . -- _ ___ _ _ . . _ - �---------- _ _. _. <br /> First Middle Last <br /> j--��, . <br /> � `/ �� �..`aY��'� � � --- ._ _ _ _ _.. _ . _. - <br /> Address , ���� � <br /> 1 � <br /> �� . <br /> ,���jl , <br /> ,i <br /> , <br /> � ' '�'JJ�/`7'"] .---� �v'.. ..__ � __ __. .__ . .. _ ...__. ._.'- - - -- - - -- - <br /> -----�.. . _ --- - <br /> City — , � State Zip <br /> � � �:�_� �- - - --- - --- - - <br /> Phone <br /> I understand my rights as stated above. <br /> ., <br /> ,/`�'�.,. �� ���''' - - <br /> Signat re� <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION�&FINANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />